Open Sesame!
These are the magic words uttered by Ali Baba in the English adaptation of Ali Baba and the Forty Thieves from Arabian Nights tales. Magicians might use “Abracadabra!” or “Alakazam!” (My grandmother insisted the magic word is “please.”)
The issue of magic words was front and center in last week’s oral argument before the US Supreme Court (SCOTUS) in Medina v. Planned Parenthood South Atlantic, No. 23-1275. In 2018, the governor of South Carolina issued an order prohibiting organizations that provide abortion services from participating in the state’s Medicaid program. Planned Parenthood South Atlantic and one of its patients, Julie Edwards, sued South Carolina, claiming that the order violated the Medicaid Act provision allowing any Medicaid-eligible patient to seek healthcare from any “qualified” provider. The questions presented to SCOTUS in this case addressed whether the Medicaid Act used the right magic words to confer a private right of action to enforce provisions of the law concerning free choice of provider enforceable under 42 U.S.C. § 1983.
If you are experiencing déjà vu, it’s because this case is very similar to the 2023 SCOTUS case Health and Hospital Corporation of Marion County v. Talevski, No. 21-806. In that case, the Court held in a 7-2 decision that the Federal Nursing Home Amendments Act of 1987 unambiguously created rights enforceable under § 1983. While both the Talevski and Planned Parenthood cases involve the direct question of magic rights-creating words in a statute, the ulterior question also underlying these grants of certiorari is whether a privately enforceable right can ever be created pursuant to a law enacted under Congress’ spending clause power.
Topics for this week’s Health Announce:
- Mass Senior Action Council joins federal lawsuit to stop unlawful cuts to Social Security.
- Sign-on opportunities for commenting on ACA Marketplace proposed rules.
- Massachusetts Health Care Training Forum spring offerings announced.
- Reminder – Elder Benefits Program next week.
- Medicaid Defense Update – New tool!
Be well,
Jennifer Hotchkiss Kaplan
Senior Health Law Attorney
Massachusetts Law Reform Institute
1. Mass Senior Action Council joins federal lawsuit to stop unlawful cuts to Social Security.
Massachusetts Senior Action Council (MSAC) joined several other organizations and individual plaintiffs in filing a federal lawsuit against the Social Security Administration, the so-called Department of Government Efficiency (DOGE), and Elon Mush, among other defendants. The lawsuit challenges as unlawful defendants’ actions to cut the social security workforce, shutter offices, and cut telephone-based services – resulting in significant and irreparable harm to individuals with disabilities and older adults who depend on social security.
Plaintiffs, represented by Justice in Aging and Brown Goldstein & Levy LLP, bring claims under the Rehabilitation Act, the Administrative Procedure Act, and constitutional provisions including due process and the First Amendment. Read the complaint here.
2. Sign-on opportunities for commenting on ACA Marketplace proposed rules.
On March 10, 2025, the Centers for Medicare and Medicaid Services (CMS) posted a proposed rule, CMS-9884-P, misleadingly titled “Marketplace Integrity and Affordability.” The proposed rule covers a very broad range of policies and issues related to the Health Connector and the insurance markets in which they operate, such as new restrictions on eligibility, enrollment periods, and affordability. Some of the damaging provisions proposed include:
- Barring Deferred Action for Childhood Arrivals (DACA) recipients from marketplace coverage.
- Prohibiting gender-affirming care from being included in Essential Health Benefits (EHB).
- Increasing premiums and out-of-pocket costs by changing the calculation formula.
The proposed rule itself is dense and sweeping. Several organizations have taken the lead in drafting comment letters. Some of the letters are broad to address as much as possible; others are more targeted at specific provisions of the proposed rule. Below are two opportunities to sign on to comment letters:
Massachusetts Coalition for Coverage and Care – Sign-on Comment Letter: Proposed Marketplace Rule
- This 6-page comment letter urges CMS not to adopt certain policies, including those that would shorten the annul open enrollment period; modify annual eligibility redetermination processes for individuals in fully-subsidized plans; exclude DACA recipients from the definition of lawfully present; and prohibit gender-affirming care from being included as an EHB.
- To sign on, email mlampon@hcfama.org – Deadline April 9th
Protecting Immigrant Families -- DACA Sign-on Comment
- This 4-page comment letter focuses on opposing the proposal that would exclude people with DACA from health insurance marketplace eligibility and on endorsing the decision to retain clarifications to immigrant eligibility as well as technical adjustments included in the 2024 final rule.
- Sign on here – Deadline April 9th
3. Massachusetts Health Care Training Forum spring offerings announced.
Massachusetts Health Care Training Forum (MTF) posted its spring virtual meeting schedule. Offerings include:
MassHealth & Health Safety Net Updates – covering updates to MassHealth health plans, the ACA-3 and SACA-2 applications, the Medicare Savings Program (MSP), and more:
MA Health Care Learning Series – covering information about the closure of Health Connector’s walk-in centers, helping people who have lost employer-sponsored health insurance, and other operations and policy updates:
Find more information about MTF’s virtual meetings here.
4. Reminder – Elder Benefits Program next week.
On Thursday, April 17, 2025, from 9:30 am – 4:00 pm in person at the MCLE Conference Center and via live webcast, MLRI is chairing an Elder Benefits Program. The training covers basic eligibility rules for cash benefit programs like SSI and Social Security Insurance benefits, home-based care services from the Office of Elder Affairs, health care programs like Medicare and MassHealth, and other public benefits available to older adults in Massachusetts. Faculty include experts from MLRI, GBLS, SCCLS, CLA, AGE, and DLC.
Special rates are available for legal services attorneys. Register here.
5. Medicaid Defense Update – New tool!
In 2025, Congressional Republicans are focusing their legislative efforts on extending the 2017 Trump tax cuts, giving more and bigger handouts to billionaires and corporations. To pay for these tax cuts, Congress is considering major cuts or rollbacks to federal programs, including Medicaid (MassHealth in Massachusetts) and coverage from Affordable Care Act marketplaces like the Massachusetts Health Connector.
In an attempt to hide the Medicaid cuts they are considering, Congressional Republicans have changed their language – instead of saying “cuts to Medicaid,” they say “reforms to address waste, fraud, and abuse.” The fact remains that the only way Republicans can pass the tax cuts they want is to drastically reduce spending in Medicaid. Advocacy to protect Medicaid and the ACA rightly focuses on the real impacts to children, older adults, individuals with disabilities, and low-income individuals and families. In 2024, 2.3 million Massachusetts residents relied on these programs for their health insurance.
The attached Tables show the number of people enrolled in MassHealth and ConnectorCare by Massachusetts Congressional district, identifying the number of people in each district who would be hurt by cuts to existing programs. We hope it will help in all our work to defend Medicaid and the ACA.
